title: The role of temozolomide in the treatment of a patient with a pure silent pituitary somatotroph carcinoma.
abstract: OBJECTIVE
  To describe a case of a pure silent somatotroph pituitary carcinoma.
  
  
  METHODS
  We describe a 54-year-old female with a clinically nonfunctioning pituitary macroadenoma diagnosed 15 years earlier.
  
  
  RESULTS
  The patient underwent transsphenoidal surgery and no visible tumor remnant was observed for 6 years. A magnetic resonance imaging (MRI) detected the recurrence of a 1.2 × 1.5 cm macroadenoma. The patient was submitted to conventional radiotherapy (4500 cGy), and the tumor volume remained stable for 7 years. Then, an MRI revealed a slight increase in tumor size, and 2 years later, a subsequent MRI detected a very large, invasive pituitary mass. The patient was resubmitted to transsphenoidal surgery, and the histopathological examination showed diffuse positivity for growth hormone (GH). The nadir GH level during an oral glucose tolerance test was 0.06 ng/mL, and the pre- and postoperative insulin like growth factor type I (IGF-I) levels were within the normal range. Abdominal, chest, brain, and spine MRI showed multiple small and hypervascular liver and bone lesions suggestive of metastases. Liver biopsy confirmed metastasis of GH-producing pituitary carcinoma. The patient has been treated with temozolomide and zoledronic acid for 7 months and with octreotide long-acting release (LAR) for 4 months. The primary tumor and metastases are stable.
  
  
  CONCLUSIONS
  Despite being an extremely rare event, pituitary carcinoma may develop several years after the successful treatment of even a silent GH-producing pituitary adenoma, which suggests that close long-term follow-up is necessary.
authors.affiliation: Department of Internal Medicine and Endocrine Unit, Medical School and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro Endocrinology Section, Federal Hospital of Lagoa.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Vieira Neto
authors.forename: Leila
authors.initials: L
authors.lastname: Chimelli
authors.forename: Paulo José da M
authors.initials: PJ
authors.lastname: Pereira
authors.forename: Emerson L
authors.initials: EL
authors.lastname: Gasparetto
authors.forename: José
authors.initials: J
authors.lastname: Bines
authors.forename: Luiz Eduardo A
authors.initials: LE
authors.lastname: Wildemberg
authors.forename: Mônica R
authors.initials: MR
authors.lastname: Gadelha
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000188:drug therapy* / Q000473:pathology; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D015282:Octreotide / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000077204:Temozolomide; D000077211:Zoledronic Acid
chemical_list: D018906:Antineoplastic Agents, Alkylating; D018931:Antineoplastic Agents, Hormonal; D004164:Diphosphonates; D007093:Imidazoles; D019382:Human Growth Hormone; D000077211:Zoledronic Acid; D003606:Dacarbazine; D015282:Octreotide; D000077204:Temozolomide